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'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

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Re: 'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

#61

Post by malcolmgreaves »

idopmstuff wrote: post #47
asdajksah2123 wrote: post #23

I'm not sure I understand why AI is supposed to make anything better, at least under the regulatory regime we have right now. 1. AI doesn't do anything new. It's just human thinking done better in the best case scenario. So the plus side is that we may come up with ideas that a human might have come up with 10-15 years later. However, a lack of ideas is not the problem we face at all. We have solutions to nearly ever…

1. AI is broadly accessible. While it definitely has its downsides, I think there's a valid argument to be made that access to AI medical advice is better than access to no medical advice. 2. AI can hold vastly more knowledge in its "head" than a doctor. There are many rare conditions that a doctor rarely sees. That doctor doesn't have enough time to spend researching these kinds of things for their patients, but an…

> valid argument to be made that access to AI medical advice is better than access to no medical advice.

This is not true. And it's where I believe your whole response takes a wrong turn.

Why is it wrong? Because of risk of harm.

Giving out wrong information can easily kill people. Or permanently insure them. There's a tremendous amount of harm that can occur if you do things wrong in medicine.

When you attach "an AI said X" to something, it adds the appearance of authority. This makes it incredibly dangerous. Folks that don't know enough will believe that the "advice" is true because it "comes from an AI" (and how could an AI be wrong? It's advanced! It's smart! It _can't be wrong_ because the company is using it instead of a real Doctor, and _they wouldn't want to harm me with something that can be wrong_...right?)

For example, let's take COVID. If you had GPT say "go take hydroxychloroquine for COVID", you'd end up with a lot of people getting harmed by (1) taking a drug that's not going to help them when they _think_ it would (so they're not going to do something else for treatment, because they incorrectly think they're already being treated) and (2) there's always side effects to taking _any drug_, and these side effects may actually cause _more harm_ than doing nothing.

Re: 'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

#62

Post by staunton »

honkycat wrote: post #14

I got a new job recently and I have been saying this is what I will be doing, writing AI to deny claims, AS A JOKE. We pay taxes so the government can pay to subsidize these healthcare corps that just serve to funnel money to its already rich shareholders. Healthcare is a pathetic broken mess and it will never get better.

> it will never get better

Don't lose hope, other countries manage to be a lot better. It's possible if you only try.

Re: 'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

#63

Post by HankB99 »

> How bad is the AI? A recent lawsuit filed in the US District Court for the District of Minnesota alleges that the AI in question was reversed by human review roughly 90 percent of the time:

Isn't that about the same for non-AI interactions with US health insurance carriers? Their job is to make money and they do that by denying claims whenever they can. It's truly an awful experience.

Re: 'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

#64

Post by michaelmrose »

hackerlight wrote: post #50
thesuitonym wrote: post #24

Earlier quoted context omitted.

You don't understand because you think we have a society built around making life better for everyone. It's not. Our society currently is optimized for one thing: Making sure the rich stay rich, and the poor stay poor. In that respect, AI is amazing. AI requires a small upfront cost, then can do the job of thousands of people for the pay of less than one. It works 24 hours, and will never ask for more money. And it w…

> AI requires a small upfront cost, then can do the job of thousands of people That's the same with every efficiency improvement. Efficiency improvements (like AI) aren't zero sum. When production costs go down, competition forces prices to also go down, which then leads to more wealth for everyone not just the capital owners (even if it disproportionately benefits capital owners). People are made redundant and then…

You are assuming over the coming years that most parties so displaced simply shift to other parts of the economy as lucrative and are able to take advantage of those benefits. You are also assuming collusion explicit or implicit and the wealth of remaining buyers doesn't just keep prices high.

EG you you have 100 people who can't afford steam off a hotdog and 100 customers with n units of disposable income per day. You end up with 150 customers who can't afford shit and 50 with 2n units of disposable income. The price was never bounded by the actual cost in the first place so the smaller wealthier clientele leads to higher prices.

One could easily imagine many tens of millions of new poor making much less while prices driven by wealth of other segments of society continues to rise who both have less coming in to pay higher prices.

Meanwhile you have tens of millions of people who are presently create little value NOW whose jobs end up politically difficult to deprecate. You need to have SOME people on your side after all.

I don't see our society being a good one now or in 20 years. There is no political will to do anything hard and a thread of greed, cowardice, anti intellectualism and weakness woven through our society.

Re: 'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

#65

Post by johnnyworker »

cscurmudgeon wrote: post #55
thesuitonym wrote: post #24

Earlier quoted context omitted.

You don't understand because you think we have a society built around making life better for everyone. It's not. Our society currently is optimized for one thing: Making sure the rich stay rich, and the poor stay poor. In that respect, AI is amazing. AI requires a small upfront cost, then can do the job of thousands of people for the pay of less than one. It works 24 hours, and will never ask for more money. And it w…

Hasn't the poverty rate consistently decreased?

The gap between rich and poor is growing at increasing pace, just like the gap between rich and mega-rich is.

If you went completely hungry yesterday, nearly starved to death, but today you get enough calories that you feel less pain so you can at least stand up and walk around a bit, while you watch your brother stuff his face with so much cake he has to puke 3 times to make room for more, to then play frisbee with the rest, what would you think? How it was for you yesterday isn't the standard. How it is for others, today, is the standard. It's about fairness and human dignity, nothing more and nothing less. If everybody was starving, we wouldn't even have a name for it, or a problem with it. It wouldn't be a slight on anyone.

Some people shriek in anguish or sob in darkness, kill themselves, over issues that would be a 2 minute phone call and a check that is 0.0001% of their monthly income for someone else. That's a problem, and that kings used to have less than the average homeless do today doesn't change that, and isn't something capitalism gets to take credit for either. Humans have been inventing and improving things since before history, even animals do it, that's just normal.

Re: 'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

#66

Post by RajT88 »

> Though few patients appeal coverage denials generally, when UnitedHealth members appeal denials based on nH Predict estimates—through internal appeals processes or through the federal Administrative Law Judge proceedings—over 90 percent of the denials are reversed, the lawsuit claims.

The PHB's in charge probably view this as a win. A 10% savings!

Re: 'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

#67

Post by RajT88 »

quickthrower2 wrote: post #51
apwell23 wrote: post #29

Earlier quoted context omitted.

Why would a human also not choose a perfect CV over other options. What does this prove about AI.

You want a perfect candidate not a perfect CV. A perfect CV is highly likely to have lies and was made up based on the job ad, addressing every single requirement bullet.

Even without the lies, you can meet every single bullet point and still be a worse fit than someone who doesn't match every single bullet point.

Maybe the gal or guy who fits every bullet point has a long career and quite broad knowledge. Maybe the gal or guy who doesn't fit every single bullet point is much smarter, a much harder worker with far more grit, and a quick learner.

You end up hiring the first person who may be mediocre, and missing out on the second who may be a super high performer.

Re: 'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

#68

Post by cmiles74 »

asdajksah2123 wrote: post #23

I'm not sure I understand why AI is supposed to make anything better, at least under the regulatory regime we have right now. 1. AI doesn't do anything new. It's just human thinking done better in the best case scenario. So the plus side is that we may come up with ideas that a human might have come up with 10-15 years later. However, a lack of ideas is not the problem we face at all. We have solutions to nearly ever…

Right now, the only products I've seen leveraging LLMs are the tools from Nuance[1] that fill in physician notes. Arguably this is not an improvement; physician notes are already an incomprehensible garble of cut-and-paste content (often from other systems).[2] But at least it is unlikely to negatively impact patient care.

So far, AFAICT, the drive is to cut costs by saving the time the physician spends with the EHR. This has been a goal of the EHR systems for as long as they've existed as it saves money. There is a lot of press releases about products that do more but it's not at all clear to me that these products being widely used.

The UnitedHealthcare example in this article is interesting in that is was being used in production. OTOH, it sounds much more like something evaluating business rules or some heuristics rather than an LLM or even an ML based solution.

[1]: https://blogs.microsoft.com/blog/2023/08/22/microsoft-and-ep...

[2]: https://ehrintelligence.com/news/ehr-clinical-note-length-co...

Re: 'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

#69

Post by LegibleCrimson »

staunton wrote: post #58
LegibleCrimson wrote: post #35

Earlier quoted context omitted.

I think the point is that one of the big hype phrases is that it will decrease costs of healthcare and lower people's bills, but even if you lower the cost, there is no actual incentive to lower patient bills, so the extra value simply goes to owners and investors rather than the end consumer.

Would you rather be treated in a modern hospital or one from 50 years ago? Would you choose the historical hospital if it charged you the same fraction of median income as it did back then?

It's not that black and white. There's more at play than just charges. Things can be better and still shockingly corrupt, with extreme amounts of unjustified overhead. Things are minimally better for any individual patient, while being extremely more expensive, and the insurance overhead has skyrocketed.

The question is a little bit like responding to a complaint about industrialized agriculture's effects on the environment by saying "Would you rather eat sausage from 100 years ago or now?" It's not actually that relevant to the initial complaint, and it reads like it's trying to just terminate the conversation on a loophole. Things can be better and still also be filled with many problems, particularly modern problems that weren't relevant in the time period you're comparing to.

To actually answer the question honestly, it depends on my condition. For the kind of thing I would typically see my GP for, including run-of-the-mill checkups, definitely one from 50 years ago. For any serious medical issues, modern (as long as I can convince the doctors that it's actually serious so they spend more than 30 seconds on investigation).

As far as charges go, per-capita healthcare expenditure is now over 5 times as high as it was in 1980. Are we getting a 5-fold improvement in medical care? When I go to the doctor for anything more than a checkup, 90% of my time is spent waiting, and I spend twice as much time with RNs who repeatedly ask me the same questions, before a frazzled doctor comes in, asks a couple questions, then rushes out, maybe handing me a prescription for antibiotics regardless of what my concern is.

Re: 'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

#70

Post by cryptonector »

manicennui wrote: post #27
protoman3000 wrote: post #26

> Even when users successfully appealed these AI-generated determinations and win, they’re greeted with follow up AI-dictated rejections just days later, starting the process all over again. Wait, what? Does that mean they can just take your money and reject your request to cover treatment until you die even if you had every right to do so?

Yes, this is what Americans mean when they parrot bullshit about freedom: the freedom for corporations to do whatever they like in pursuit of profit.

We don't have a free market in healthcare in the U.S. though. You can be for a free market and against the abomination we currently have. If we just went back to 80%/20%, high-premium-or-high-deductible proper insurance, no HMOs, no PPOs, no co-pays, none of that nonsense, with published pricing, then we'd have a free market.
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